The Histologic Discrepancy before and after Endoscopic Submucosal Dissection of Gastric Adenoma and Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: We wanted to investigate of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by endoscopic submucosal dissection (ESD). METHODS: 69 gastric adenomas and 38 early gastric cancers (EGC) that were treated by ESD from July, 2004 to February, 2006 were reviewed to analyze the relation between the histologies of the endoscopic biopsy and the resected specimen. RESULTS: The discrepancy rate between the histology of the endoscopic biopsy and the resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Among the 43 cases of low grade dysplasia, 6 cases (14%) were confirmed as gastric cancer after ESD. CONCLUSIONS: The histologic discrepancy between the endoscopic biopsy and resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Though the endoscopic biopsy may reveal low grade dysplasia, gastric adenoma should be removed by endoscopic mucosal resection because of the histological discrepancy between the endoscopic biopsy and the resected specimen.

A Case of Cavernoma of Portal Vein associated with Polycythemia Vera / 대한간학회지

in the leg and the toe and was treated with angioplasty and thrombolytic therapy with phlebotomy.

Four cases of ticlopidine-induced cholestatic hepatitis / 대한내과학회지

Ticlopidine, a potent antiplatelet agent, is widely used for treatment of coronary artery disease and cerebrovascular disease. Adverse effects has been reported in 10% to 20% of patients receiving ticlopidine. The most commom adverse effects were gastrointestinal disturbance, skin rash, but cholestatic hepatitis with jaundice was rare (0.1% incidence). We have recently experienced four cases of ticlopidine-induced cholestatic hepatitis after coronary artery stent insertion. Jaundice developed within 1 month of starting ticlopidine at recommended daily doses. In all cases, jaundice resolved and serum liver enzymes improved over a period of months after drug withdrawal. Therefore, clinicians should be aware of the reversible condition of ticlopidine-induced cholestatic jaundice that slowly resolves after drug withdrawal.

Study on the therapeutic efficacy and complications of radio-frequency ablation according to the diameter and location of hepatocellular carcinoma / 대한내과학회지

BACKGROUND: Induction of coagulation necrosis by using thermal energy sources such as radio-frequency (RF), microwaves and lasers has recently been as a new, minimally invasive technique for percutaneous tumor ablation. RF ablation is considerd effective and safe for the local control of small HCCs. The aim of this study is to evaluate the therapeutic efficacy and complications according to the diameter and location of the HCC. METHODS: Between May 1999 and December 2000, one hundred fifty patients underwent RF thermal ablation in Dong-A university hospital. Among them, forty nine patients were enrolled in this study who have no history of prior other treatment including hepatic resection, TAE, PEI, and chemotherapy, also who have follow-up CT performed at least six months after ablation. The patients devided into two groups, who have small HCC (3 cm in diameter), the mean follow-up duration was 10.8 months and local recurrence rate was 51.0%+/-12.4. In small HCC group (

Emergence of YMDD motif mutant hepatitis B virus during long-term lamivudine therapy / 대한내과학회지

BACKGROUND: The emergence of YIDD or YVDD mutant hepatitis B virus (HBV), with point mutation in the YMDD motif of DNA polymerase gene, has been reported in patients with lamivudine treatment group. The aims of this study was to investigate the emergence of mutant HBV during long-term lamivudine therapy using nested polymerase chain reaction (PCR) method and direct DNA sequencing. METHODS: Twenty-one chronic hepatitis B patients with HBeAg and HBV DNA positive were evaluated. During lamivudine therapy, there were reported breakthroughs of HBV DNA (over 50 pg/mL) when investigated the emergence of YMDD mutants by nested PCR method using restriction fragment length polymorphism (RFLP) in all patients. Direct DNA sequencing of HBV DNA polymerase gene including YMDD motif was also performed. RESULTS: There were 13 patients (61.9%) with YIDD mutant and 8 patients (38.1%) with YVDD mutant. The results of direct DNA sequencing were consistent with those of nested PCR data based on RFLP. The breakthrough was occurred at 15 to 106 weeks (57.9+/-23.6). At the point of breakthrough, the level of ALT was 74.8+/-117.7 (14-546) IU/L, and it was lower than the level of ALT before the therapy. CONCLUSION: In the long-term therapy of lamivudine, the emergence of YMDD motif mutant HBV was related to the breakthrough of HBV DNA and YIDD mutant was frequent. The nested PCR method using RFLP may be simple and sensitive to detect the YMDD motif mutant HBV.

Usefulness of Ergonovine Echocardiography in Patients with Acute Coronary Syndrome and Suspected Variant angina

BACKGROUND AND OBJECTIVES: It is well known that coronary spasm can cause acute coronary syndrome (ACS) such as unstable angina or acute myocardial infarction as well as variant angina. But the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore we tried to investigate the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram (CAG) and suspected variant angina. MATERIALS AND METHOD: Since July 1999 to June 2000, 53 consecutive patients were enrolled for this study (mean age 56+/-10, 44 male). Clinical manifestations of the patients are acute myocardial infarction (8), unstable angina (17) and suspected variant angina (28). Ergonovine maleate was administered intravenously (50 microgram at 5 minute intervals up to total cumulative dosage 350 microgram) with continuous echocardiographic monitoring. Positive criteria of this test was reversible regional wall motion abnormality by echocardiography. RESULTS: This test was completed in all patients without major cardiac event or malignant arrhythmia. Forteen patients (14/53, 26%) showed positive test: their clinical diagnosis was AMI in 2, unstable angina in 6, and variant angina in 6. Four cases were positive without chest pain or electrocardiographic change. CONCLUSION: Ergonovine echocardiography is a safe and useful method in diagnosing coronary vasospasm in ACS with normal CAG and suspected variant angina without ST segment change.

The Influence of the Vertical Location of VDT Screen on the Ocular Dryness

The fatigue of eye is much caused by eye dryness during VDT work. We performed this study to find out whether eye dryness is reduced wit the computer screen which is placed lower than primary gaze during VDT work. Forty people without eye disease were selected. One VDT screen was placed 5degreesabove the primary gaze(5degreesup screen) and the other 25degreesbelow the primary gaze(25degreesdown screen). We measured the frequency of blinking and vertical palpebral fissure height, at rest and while they enjoyed an interesting computer game for 20 minutes. Tear film break-up time(BUT) was also measured at rest, during and immediately after computer game. At rest, the average frequency of blinking was 22.35+/-6.28/min and BUT was 10.20+/-2.63 seconds. During VDT work with 5degreesup screen, the measurements were significantly decreased to 7.48+/-3.43/min and 5.38+/-1.43/min, respectively. These, however, were improved with 25degreesdown screen showing 10.05+/-4.59/min and 7.00+/-1.55 second(p>0.01). The average vertical palpebral fissure height was 6.49+/-1.07mm at rest, and 9.49+/-1.26mm with 5degreesup screen. With 25degreesdown screen, this was 7.69+/-1.01mm and narrower than the measurement with 5degreesup screen(p>0.01). This study reveals that the visual fatigue from the ocular dryness will be improved with the computer screen placed 25degreeslower than primary gaze and laid adeqately back like in reading position.

Co-cultivation of Adenovirus with Cultivated Conjunctival Epithelial Cell: Morphological Changes in Infected Cell

This study was performed to investigate the morphological changes of the human conjunctival epithelium when the cultured conjunctival tissue was co-cultivated with the inoculated adenovirus. Specimens swabbed from the lower conjunctival sac of patients with epidemic Keratoconjunctivitis were inoculated into the cultured conjunctival epithelial cells and co-cultivated. The adenovirus-infected cell revealed viral particles, crystalline arrays of adenovirus, paracrystalline inclusions and three types of inclusions within the nucleus. The cytoplasm did not show the specific pathologic changes. These results suggest that adenovirus can be co-cultured with conjunctival epthelial cell and the infected cell showes the typical morphological changes within the nucleus. This in-vitro co-cultivation of adenovirus with conjunctival epithelial cell may be used for an in-vitro model in the research of adenovirus.

Collateral Circulation in the Branch Retinal Vein Occlusion

Collateral circulation that develops in the chronic stage of branch retinal vein occlusion (BRVO) was known to affect the cliniral course of this disease. To study the development of collateral circulation according to the types of BRVO, 45 eyes with BRVO in which fluorescein angiographies(FAG) were taken more than two times were divided into 3 groups by the combination of the area of capillary non perfusion and the amount of cotton wool patches. Group I showed a small area of nonperfusion, group II, a wide-spread nonperfusion area with no or several cotton wool patches and group III, a wide-spread nonperfusion area with predominant cotton wool patches. The collateral and the venovenous anastomosis was further subdivided into high-low anastomosis, bridging vessel and recanalization. Then we compared the incidence of collateral vessels in each group. As a result, in group II and III, higher incidence of arteriovenous anastomosis, arteriovenous and venovenous anastomosis was recognized compared to group I. In the cases of major temporal vein occlusion, higher incidence of arteriovenous anastomosis compared to the cases of macular branch vein occlusion. And in group III, higher incidence of neovascularization was found compared to group I.